Montevideo 30 September 2024. In the framework of the Week for the Prevention of Unintended Pregnancy in Adolescence and the International Contraception Day, a webinar on Contraception in Adolescence was held on 21 September.
The opening was in charge of Dr. Marisa Labovsky and Dr. Silvia Silvia Oizerovich, presidents of FIGIJ and expresident of REDISSER, respectively, who introduced Dr. Sonja Caffé, PAHO regional advisor on Adolescent Health, for the introduction of the webinar.
Caffé said that the Latin America and Caribbean region (LAC) has the second highest adolescent pregnancy rate in the world and the slowest rate of reduction. ‘This is not acceptable and does not reflect the level of development of the region,’ she said.
She also said that it is important to consider the impact of this situation on adolescents, but also on their families and communities. ‘Adolescent pregnancy is associated with higher maternal mortality, which is a problem in our Region, but it is also associated with other social and economic aspects that affect the development of these adolescents and of societies as a whole.’
Caffé explained that, according to United Nations estimates, between 2015 and 2021 a reduction of around 20% in the adolescent pregnancy rate was achieved in LAC, but this reduction has not been equal in the countries and, in addition, there are differences within countries. ‘It is critical to join forces and make sure we reach the most vulnerable girls with evidence-based interventions. We know that contraceptives are a proven strategy, which goes in that direction.’
Teresa Bombas, president of the European Society for Contraception and Sexual and Reproductive Health, moderated the participation of the three speakers.
Effective contraceptive interventions for the reduction of unintended pregnancy in adolescents
Dr. Rodolfo Gómez Ponce de León, PAHO's Regional Advisor on Sexual and Reproductive Health, said that there is a huge unmet need for family planning in the Region and that this is worse among adolescents and, in particular, among the most vulnerable groups.
‘It is important to have legal frameworks that favour access to contraception for the entire population, quality health services, trained personnel, communities that know and demand their rights, and adolescents with the capacity to make informed decisions,’ he said.
While Gómez mentioned that there is no method that is 100% safe, he highlighted the effectiveness of modern, reversible, long-acting methods (LARCs), which are over 99% effective and have the advantage that they are not dependent on correct use.
For this reason, he said LARCs should be the first choice when offering contraception, especially to adolescents. ‘If we could give one of these methods to adolescents who do not want to become pregnant, we would reduce unintended pregnancies by 60%, reduce abortions (which in our Region are often unsafe) by 58% and reduce maternal mortality by 67%. This has a huge impact on the development of countries.’ The consultant mentioned that for every dollar spent on satisfying the contraceptive needs of the adolescent population, the country saves 3.7 dollars in the costs of maternity services required.
In LAC, 90 % of obstetric events (births, caesarean sections, abortions) are institutional. In this context, Immediate Contraception Post Obstetrical Event (ICPOE) is a fundamental strategy to prevent second pregnancies.
PAHO's Latin American Centre for Perinatology - Women's Health and Reproductive Health (CLP/WR) designed courses on Family Planning and ICPOE for health personnel, which are available free of charge in Spanish, English, French and Portuguese on the organisation's Public Health Campus.
In closing, Gómez stressed the importance of counselling and reminded that the decision should always be in the hands of the adolescent.
Practical management of LARCs adverse effects
Dr. Asha Kasliwal, chair of FIGO's Contraception Committee reaffirmed that LARCs are the most effective methods, but noted that use in adolescents is low. ‘We need to think about what are the barriers to this. Some of them could be: that adolescents are less familiar with these methods; access; lack of knowledge on the part of health personnel; or resistance on the part of families.
The specialist expressed that counselling is key and said, ‘Adolescent girls should not be underestimated. We must provide appropriate counselling, transmit reassurance and confidence, be sensitive to their needs and address the concerns of adolescents with objective information’.
In this regard, she said it is essential to convey the right messages, to talk about the adverse effects and also the benefits associated with this type of method.
She then reviewed the different LARCs available and discussed the possible effects that may arise, pointing out when switching to another method should be considered.
Thirty years after the International Conference on Population and Development, where do we stand on sexuality education?
Dr. Venkatraman Chandra-Mouli, Advisor on Adolescent Health for WHO began his intervention by highlighting the importance of the 1994 International Conference on Population and Development, as it was the first time that sexual and reproductive health and rights were placed on the global agenda.
Thirty years after that milestone, he said there were several things to celebrate, but he felt that while there had been progress, it was slow and uneven. ‘The conclusion is that we have worked in a disorderly manner and we have made mistakes. We also know that when we work together we have a better chance of generating change.’
Chandra said, ‘There is strong evidence that children and adolescents need sexuality education. When it is well designed and well delivered, it is effective. And there is evidence that it does no harm.’
He said that sex education has an impact on contraceptive use, but also on experience. ‘Sex education programmes prepare people to have a safe and pleasurable sexual and reproductive life’.
Sexuality education is increasingly present in international commitments and in countries' strategic policies and guidelines. ‘However, the content is often poor, often late and does not respond on the interests of adolescents. It often focuses only on the biological aspects,’ he said.
‘The approach to sexuality education has evolved...We are starting to talk about sexual and reproductive rights and justice. Promoters of sexual education are making an effort to have increasingly inclusive content. Topics such as healthy relationships, abuse prevention, consent, among others’.
He also pointed out that there are still groups that oppose these initiatives and it is important to know that they are very well organised and well funded, so they should not be underestimated and unfounded attacks should be countered.
Finally, the expert stated that it is important to look for strategies to reach those adolescents who are not attending schools.
Conclusions
After the lectures, Dr. Gabriela Perrotta coordinated the question and answer section, which also included reflections by Dr. Zuzana Niznanska and Dr. Veronica Fiol. The specialists reinforced some of the concepts that were expressed during the seminar, such as:
- It is fundamental to guarantee the sexual and reproductive rights of all people.
- Contraception in adolescence allows to reduce unintended pregnancy. LARCs are the best option and ICPOE is a strategy to prevent second pregnancies.
- Access to information and education needs to be improved.
- The impact of adolescent pregnancy should not only be considered in biological terms but also in terms of its social and economic impact.
- Rights should not be taken for granted; there are always threats.
- Contraception is not only useful to avoid pregnancy but also to be able to experience a full and enjoyable sexuality.
The event was organised by PAHO, through CLP/WR, jointly with FIGIJ, ESC, FIGO and REDISSER.
